Table 5

Technical implementer responses

EMR systemOpenMRSDREAM–Sant EgidioGHISiSantéWorldVistaOSCAR
Type of server at back end
 BrandDell Power Edge 1950HP, DellDellHP, DellAnyDell
 Type of processors
  • Intel Xeon

  • 5400 series 3.33 GHz

  • Intel Xeon

  • Intel Dual Core

Intel Dual Core
  • Intel Dual Core

  • Others

X86, VAX/AlphaI7
 Number of processors411111
 Total hard drive capacity4 GB250 MB100 GB1 GB200 MB500 MB
 Hard drive capacity in use500 MB80 MB15 GB500 MB200 MB
 Hard drive configurationRAID 1RAID 1No raidNo raid
 Server operating systemLinux, WindowsWindowsWindowsWindows/LinuxLinux, Windows, Unix, VMSLinux, Mac OSX and Windows
 Web serverApacheNot applicableApacheApache/IISApache, IISApache Tomcat
 Database running EMR systemMySQLMS SQL ServerMS SQL Server
  • MySQL

  • MS SQL Server

Any that have compatible APIsMySQL
 Other software requiredJava JDK 1.6 +, PHP 5.3+MS AccessMS VB.NetLDAP, Perl, Cygwin (Windows only), Java, JasperReportsSun Java
 Cost of serversUS$4000–$5000US$2000US$1500US$10 000US$2000US$1000
Type of workstations running the EMR back end
 BrandPC, NetBook, TabletHP, DellDellHP, DellAnyDell, Any
 Type of processor1.5 GHz any processorsIntel Pentium 4, Intel Core 2 Duo, Intel Celeron, AMDIntel CeleronIntel Dual Core, OthersX86Pentiums mostly about 5 years old
 Hard drive capacity2 GB80 GB80 GB500 MB200 MB100 MB
 Operating system running workstations for the EMR front endLinux, Windows, OSXWindowsWindowsWindowsLinux, Windows, OSXLinux, Windows, OSX
 Cost of a typical workstationUS$1000US$1000US$700US$1000US$400US$600
 Type of networkEthernet, GPRS, 3GEthernetEthernetEthernetEthernetEthernet
 Type and number of switchesLayer 2 and Layer 3 Fast Ethernet SwitchsRouters, number varies according to site requirements.1 linksys routerEthernetDlink
 Network bandwidthEthernet, Fast EthernetFast EthernetEthernet, Fast EthernetEthernet, Fast EthernetFast Ethernet
Backup system
 Backup up functionality
  • Yes

  • Management User, role and group

  • Administration module

  • Edition advanced data record.

  • Administration service web.

  • Yes

  • Standard MS SQL backup system, plus a daily copy of the database to another computer, and to the head office.

  • Yes

  • scheduled backup to portable devices used to update master database

  • Yes,

  • Standard OS File system backup + standard database backup + custom application data replication to remote server

  • Yes,

  • Cron job that runs an encrypted compressed backup of the database and documents daily

 IT providers related to the IT infrastructure
  • Lazos: Responsible of the operation and platform

  • Frontera University: Center excellence Software Engineering, responsible of the proyect and development.

DREAM local IT StaffIn-house IT department of ministry of health responsible for installation maintenance and repair of all hardware and softwareCIRG (Clinical Informatics Research Group) developed and supports the application. I-TECH Haiti IT staff and CDC staff supports the application in HaitiOscar Service
System deployment
 Number and roles of people involved in deployment tasks
  • 1 Manager Development and coordinator team

  • 1 Analyst Quality and Testing

  • 2 Software Engineers

  • 1 Systems Administrator

2 technicians in country for deployment tasks with Servers administration and Network proficiency.
  • IT department technicians

  • Site coordinator (system manager/administrator)

  • Trainer

8–10 IT personnel do physical installation of hardware and installation and configuration of software across all sites in country1 programmer from Oscar Service for install and one trainer from Oscar Install. Both done remotely via the internet
 Overall estimated time for EMR software deployment (not including hardware/network)8 months1 h for 10 computers1 month3 days for software installation and trainingHalf day training session over the internet
 Estimated cost for configuration and installation of software (not including hardware/network)US$120 000US$10 per site of 10 computersUS$5000US$1500.00
EMR interface usability
 EMR interface design follows standards/best practicesISO 9241ISO 9241NoISO 9241ISO 9241
 EMR interface intuitive and easy to learn for new users?YesYesYesYes
  • Yes,

  • You can teach it over the internet. Locums are able to manage the system with minimal instruction by my nurse (15 min)

 EMR interface easy to remember for users?Yes
  • Yes

  • It has good layout, functions buttons always in the same area and basic functions just a few clicks away.

  • No

  • Requires time to get accustomed to NEW forms and reports

  • Yes,

  • Same routine daily

EMR performance
 Number of users of the EMR system20 per site3–10 per site5 per site20
 Average number of concurrent users utilising the EMR system1083–10310
 Maximum number of concurrent users utilising the EMR system40No defined limit.3–1010No real limit
 Current size of database files26 GB, 4.000.000 records500 MB.70 MB1.27 GBBackups fit on a DVD. 1.2 GB for documents and 240 MB database (Gziped)
 Average availability of EMR systemAlways availableAlways availableUnavailable once a weekAlways availableAlways available
 Average down time of EMR system when it fails<1 h<30 min<1 day<1 h<1 min
Subjective speed of EMR
 When entering patient data2 s0.5 sInstantAdequateNo delay
 When accessing patient data3–5 s1 sSecondsAdequate for single patient access; large reports are cached and/or run overnightDepends on the file. Opening a large patient file can take 3 up to 30 s with an internet connection
 When sending queries for reporting120 s3 sDepends on complexity of queryAggregate real-time reports may take up to 30 min in some cases, but most standard reports take 30 s or lessDepends on the query. Some whole database conversions to CIHI XML format can take up to 20 min
 EMR system integrated with other software?
  • CMS Typo3

  • Medica Agenda

  • Yes

  • OpenELIS (lab info system)

  • Yes

  • Local hospital reporting system. External laboratory reporting system

 Standards used for transferring informationOpenEHR, LOINC
  • No

  • Connected by Custom interface

EMR maintenance
 Who provides operational maintenanceOn-site resourcesOn-site resourcesIT department technicians
  • CDC Haiti staff/

  • I-TECH Haiti IT

On-site resources
 Who is in charge of fixing EMR software bugs and developing new functionalities?External companyOn-site resources
  • IT department technicians

  • Site coordinator (system manager/administrator)

  • CIRG (Clinical Informatics Research Group—University of Washington)

 Overall cost of EMR maintenanceUS$5000 per monthNoneUS$15 000 per yearNo contract with our installer and upgrade locally. This does take time which I don't bill for … about 8 h to convert, test, and then convert live data.
EMR system deployment
 Who was in charge of system deployment?External companyOn-site resources
  • IT department technicians

  • Site coordinator (system manager/administrator)

  • CDC Haiti staff

  • I-TECH Haiti IT

External company
 Time for system deployment2–3 sAround 1 h for 10 computers.1 week3 daysQuite some time as they had to convert our existing proprietary EMR data to the Oscar standard. Apprx 50 h. A de novo install of Oscar is the time to install Ubuntu plus 15 min.
 How many people were involved in the deployment tasks?3–5 Technician1 Technician4 Technician1 Technician2 Technician
 Time required for user training1 week15 min for each section of the programme1 week1 dayOne half day
 Who conducted training tasks?Software communityIn-site resources
  • IT department trainer

  • Site coordinator (system manager/administrator)

  • CDC Haiti staff

  • I-TECH Haiti IT

External company
 Number and roles of staff involved in training tasks
  • 2 roles

  • 1 Coordinator

  • 1 assistant

One DREAM local IT Senior Staff.
  • IT department trainer

  • Site coordinator (system manager/administrator)

One I-TECH Haiti trainerOne external employee and all the clinical and secretarial staff
 Software currently has training manuals for the following:IT Technical staffReceptionists, clinicians, pharmacy staffReceptionists, physicians, nurses, counsellors, DOTS staff, pharmacy staff, site coordinator, IT technical staffClinicians, users, IT technical staffReceptionists, clinicians, pharmacy staff, IT technical staff
  • EMR, electronic medical record.